As the United States prepares to introduce the massive new health-care program known as Obamacare, Britain’s Conservative Prime Minister David Cameron said on Monday that he plans to significantly reform his country’s state-run health-care system due to the program’s massive cost and lackluster performance.

Cameron’s plan calls for allowing patients’ general practitioners more control over treatment, in contrast to the current system, in which government bureaucrats wield greater control. His government argues that this is the only way to increase productivity while controlling costs.

Reforming the popular National Health Service, a massive government agency tasked with ensuring free “cradle to the grave” health insurance for every UK citizen, has long been considered the third rail of British politics. During a radio interview with the BBC on Monday, Cameron called Britain’s much-vaunted NHS “second rate.” The opposition Labour party quickly pounced, calling Cameron’s statement an insult to “millions of NHS staff.”

In a letter published in the Times of London on Monday, the British Medical Association, Royal College of Nurses, and health-care worker trade unions called the plan “extremely risky and potentially disastrous.” With more than 1.3 million workers, the NHS is the largest employer in Great Britain and the fourth-largest in the world. It costs the nation of 60 million people about 100 billion pounds ($158 billion) a year.

The prime minister insists that Britain’s public services must change. “Every year without modernization the costs of our public services escalate. Demand rises, the chains of commands can grow, costs may go up, inefficiencies become more entrenched,” Cameron said in a speech at the Royal Society of Arts in London. “Pretending that there is some ‘easy option’ of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.” Cameron also reiterated his support for the NHS in the speech, saying that “a free NHS at the point of use, for everybody” was “part of Britain, part of Britishness.” He said that the reforms would only be introduced gradually.

James Kirkup, a political correspondent for Britain’s Daily Telegraph newspaper, summarized Cameron’s message. “Mr. Cameron is telling us two things today. First, this is a crucial year for public service reform. Without urgent action, services will decline and real people will suffer real pain,” Kirkup wrote. “Second, that same public service reform will ‘steady,’ not be rushed or hurried.”